It is often involved and may be the only sign of a fracture on the examination. Cheek and lip numbness can also indicate that an orbital floor fracture is present given that the infraorbital nerve runs along the floor. Any malpositions or depressions in comparison to the normal side by the supra vertex and submental views should be noted.ģ. The orbital rims should be palpated for tenderness and step-offs, as should the malar eminence.
It is important to consider the surrounding facial structures for injury when an orbital fracture is present, namely, a zygomatic complex fracture or other facial fractures. Also, the globe is sunken down and back relative to the right eye, which is consistent with a significant floor fracture. The motility examination indicates that extraocular muscles may be impinged or paretic, possibly from an orbital fracture. The entire injury appears to be localized to the periorbital area, and the extent of the injury cannot be fully determined on external appearance alone. 82.2 Coronal computed tomography scan showing left orbital floor fracture and prolapse of orbital soft tissue.Ģ. The other major concern would be ruling out an injury to the globe.įig. The patient had no loss of consciousness with the injury and had a normal neurologic examination. When evaluating patients with orbital and facial trauma, the more serious injuries need to be ruled out first, such as airway, breathing, circulation intracranial injury, and vision-threatening problems. 82.1 A 45-year-old man with restriction of superior gaze following left periorbital trauma.ġ. The left eye also appeared lower compared with the right ( Figs. On the left, motility was limited in upgaze only and enophthalmos was present. Significant diplopia was present in upgaze, and he complained of mild pain with eye movements. Pupil examination and vision were normal in both eyes. Physical examination showed a healthy-appearing man with periorbital ecchymosis. He was otherwise healthy, with no medical or ocular history. Subjectively, he had no difficulty seeing out of the eye but noted that his cheek was numb on the left side. He reported that he was struck in the left peri-orbital area. Persistent double vision can be treated with prism glasses or botulinum toxin injections, but may require eye muscle surgery.The patient is a 45-year-old man involved in a motor vehicle collision who presents with double vision and pain with eye movements. During surgery the fractured bone is repositioned and any trapped tissue is released. You may need surgery if your symptoms such as double vision or pain persist. Your doctor may also prescribe oral steroids and antibiotics. You may be given decongestants to help drain blood and fluid accumulation in the sinuses. Immediate treatment for orbital blowout fractures includes placing gauze gently on the injured area to stop the bleeding, tilting the patient to one side so that the blood flows out easily and placing ice packs to reduce swelling. Severe injury can cause damage to the eye -hyphema (bleeding of the anterior chamber of the eye) or retinal detachment – and to the skull or brain. Orbital blowout fractures are characterised by: These fractures are mainly caused due to injuries with blunt forces during sports, fights or accidents.
An orbital blowout fracture is the breaking of one or more bones in the orbital region of the eye because of trauma. It is made up of bones that surround the eyes, protecting and holding them in the right place. The orbit is a hollow structure in the skull where the eye is positioned. Home » Conditions and Procedures » Eye Injuries » Orbital Blowout Fractures
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